Current Endovascular Management of Arterial Complications After Pediatric Liver Transplantation in a Tertiary Center
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Published:2023-10-13
Issue:11
Volume:46
Page:1610-1620
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ISSN:0174-1551
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Container-title:CardioVascular and Interventional Radiology
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language:en
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Short-container-title:Cardiovasc Intervent Radiol
Author:
Marra PaoloORCID, Muglia Riccardo, Capodaglio Carlo Alberto, Dulcetta Ludovico, Carbone Francesco Saverio, Sansotta Naire, Pinelli Domenico, Celestino Antonio, Muscogiuri Giuseppe, Bonanomi Ezio, Fagiuoli Stefano, D’Antiga Lorenzo, Colledan Michele, Sironi Sandro
Abstract
Abstract
Purpose
Pediatric liver transplant surgery is burdened by arterial complications whose endovascular treatment is not standardized. We report the outcomes of a cohort of pediatric recipients with hepatic artery complications treated by endoluminal procedures.
Materials and Methods
From December 2019 to December 2022, consecutive transplanted pediatric patients who underwent endovascular treatment of hepatic artery complications were reviewed. The analysis included: type of complication (occlusion, stenosis, pseudoaneurysm); onset (acute = < 15 days, subacute = 15–90 days, late = > 90 days); endovascular technique (angioplasty, stenting); complications and outcomes. Technical success was defined as the opacification of the hepatic artery at the final angiogram with < 50% residual stenosis and no pseudoaneurysms. Clinical success was defined by graft’s and patient’s survival.
Results
Seventeen patients (8 males; median age 33 months, IQR 9–103) underwent 21 hepatic arteriography procedures for predominantly acute or subacute occlusions (n = 7) or stenosis (n = 11) with concurrent pseudoaneurysms (n = 4). Primary and secondary technical success was achieved in 13/18 and 3/3 procedures, respectively, with overall technical success of 76%. Angioplasty alone was successful in 5/21 procedures; stent-retriever thrombectomy was performed in one occlusion with thrombosis; stenting was required in 9/17 (53%) patients. Clinical success was obtained in 14/17 (82%) patients with hepatic artery patency after a median of 367 days (IQR 114.5–500). Clinical failure occurred in 3 permanent occlusions, with 2 deaths and 1 re-transplantation. Procedure-related complications included minor events in 3/17 (18%) patients and 1/17 (6%) death.
Conclusion
In liver transplanted children with hepatic artery complications, endovascular treatment may provide clinical success, with stenting often required in acute and subacute conditions.
Level of Evidence
Level 4.
Graphical Abstract
Funder
Università degli Studi di Milano - Bicocca
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging
Reference37 articles.
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